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Delirium Tremens: Risk Factors and Treatment for DTs

Giving up alcohol is incredibly difficult, but it can also be dangerous for people with a history of alcohol abuse. People who drink heavily are at risk for a condition called delirium tremens, or DTs.

Before you quit drinking, it’s important to know the symptoms and risk factors of DTs so you can protect yourself from potentially life-threatening outcomes.

What are delirium tremens from alcohol?

Delirium tremens is a very serious medical condition associated with withdrawal from alcohol. It causes the patient to have hallucinations and seizures and can result in death if not treated immediately. The risk is highest among heavy drinkers – those consuming substantial quantities of alcohol daily.

The term “delirium tremens” or DTs refers to a set of symptoms that includes disorientation, confusion, anxiety, agitation, shaking, visual and/or auditory hallucinations, cocaine-like tactile symptoms (formication), nausea, vomiting, and fever.

DTs are associated with severe complications when quitting alcohol use is either abrupt or prolonged.

The DTs usually appear when the patient’s blood alcohol level falls below 0.06%, which can happen during the first two days after stopping alcohol consumption.

It is a result of severe withdrawal from alcohol which can turn fatal if it is not properly treated.

Fortunately, with improved diagnostic measures and interventions, the mortality rate of DTs has dropped in recent decades from 35% to around 2%. But the catch is you have to seek medical attention immediately.

What are the symptoms of delirium tremens?

Symptoms of delirium tremens typically manifest within 48 to 96 hours after the last drink and can include severe manifestations such as agitation, global confusion, autonomic hyperactivity, and hallucinations.

Patients with delirium tremens often experience a significant disturbance in their mental status, which can be accompanied by tremors, seizures (indicating a high risk of seizure), and may present with anxiety or panic attacks.

Symptoms include:

  • Seizures
  • Visual hallucinations
  • Tactile hallucinations, where patients feel something crawling under their skin
  • Disturbed sleep patterns causing insomnia for more than three days
  • Restlessness or constant waking
  • Confusion, agitation, irritability
  • Anxiety
  • Fits of rage or fear
  • Grand mal seizures, which are characterized by loss of consciousness and violent muscle contractions on both sides of the body.

These symptoms are extremely serious. Contact your doctor immediately if you experience them after stopping alcohol.

empty hospital bed and room
Recognizing the symptoms of delirium tremens.

What are the risk factors of DTs?

There are many risk factors for DTs, including :

  • Alcohol dependence
  • Chronic alcoholism
  • Abrupt withdrawal from alcohol consumption
  • Severe electrolyte imbalances
  • Concurrent use of sedatives, anxiolytics, and/or hypnotics
  • Old age
  • Underlying health issues like liver disease or traumatic brain injury
  • Having a psychiatric disorder
  • Poor diet

Source: https://americanaddictioncenters.org/alcoholism-treatment/delirium-tremens-symptoms-and-treatment

Who is most likely to get delirium tremens?

Patients who have a history of severe alcohol withdrawal are most at risk for DTs. In addition, those patients who experience severe or prolonged withdrawal symptoms have a greater risk for developing delirium tremens as do those with alcoholic cirrhosis and those who have been drinking heavily for several years.

Additionally, the following are strong predictors of delirium tremens:

  • Past history of delirium
  • Alcohol-induced psychosis
  • Cognitive deficits
  • Acute mental illness
  • Past hospitalizations

With early treatment, the mortality rate [of DTs] has decreased to less than 5%.

Source: https://www.ncbi.nlm.nih.gov/books/NBK482134/

What are the common treatments for delirium tremens?

The treatment of DTs usually involves a comprehensive approach that include:

  • Supportive therapy
  • Monitoring, and
  • Specific pharmacological interventions

Supportive therapy includes creating a calm environment, providing reassurance, addressing fluid and electrolyte imbalances, and managing any coexisting medical conditions.

Patients with DT often require intravenous fluids for rehydration, with fluid requirements ranging from 4-10 liters in the first 24 hours due to significant dehydration commonly seen in severe alcohol withdrawal.

Treatment will also likely include thiamine administration, which is essential to prevent Wernicke encephalopathy and Korsakoff syndrome.

Lastly, benzodiazepines are often used to manage symptoms like agitation and hallucinations.

How many years do you have to drink to get DTs?

There’s no definitive number of years of drinking that determine whether you will experience DTs if you quit drinking.

Again, it boils down to risk factors. People with a history of severe withdrawal symptoms or having gone through withdrawal in the past are more likely to experience DTs. Additionally, genetic factors, your medical history, and alcohol consumption all contribute to your risk.

Even if you have not experienced delirium tremens before but you have had serious alcohol use, it is advised to seek medical help immediately if you decide to stop drinking. This way, you can receive medical supervision and care as you detox from alcohol.

Are delirium tremens reversible?

Delirium tremens are reversible if treatment begins right away. However, without proper care and supervision, the patient may risk death due to decreased respiration rate or cardiac arrest.

If you or someone you know has experienced delirium tremens, take them to the emergency room immediately.

Bottom Line: Take DTs seriously.

Delirium tremens is nothing to play with. It is easy to be in denial about the severity of our drinking. This leads many people to try to tough it out or detox from alcohol at home without any medical assistance.

But doing so comes at great risk. If you have risk factors for DTs or experience any symptoms of DTs after quitting, seek medical attention immediately. It can save your life.

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2 Comments

  1. My last drink was July 15 2022 I am an alcoholic I can no longer kid myself that after 30 or 60 or even 90 days I will be able to moderate. I have quit for those periods of time before so did not consider myself before as an alcoholic but each time despite the rules I put in place I always lose my moderation ability. This was my worst and I recognize I have to STOP… Today is day 4 and my withdrawal is getting better.

    I start counselling on Thursday of this week and restarted mindfulness meditation and regular exercise any other tips on your success or things to avoid my first 30 days?

    1. The biggest tip is to stay busy and lean heavily on your support networks. Any time you feel your resolve weakening, reach out to your support team. Be proactive and understand that any temptation or craving you feel is temporary and will pass.